CANCER AND YOUR HEALTH……… (part 1)
Written By Uwaeme Ebenezer(RN)….staff at Nigerite limited health center
Cancer is characterized by abnormal, unrestricted cell proliferation. Malignant tumors invade healthy tissues and compete with normal cells for oxygen, nutrients, and physical space..
The diagnosis of cancer is frightening for most people, although reactions of clients depend on the particular diagnosis, location, stage, treatment, effects on bodily functions, and prognosis
PATHOPHYSIOLOGY OF NEOPLASM/TUMOR
The cell is the basic structural functional unit in plant and animals life. Differentiated cells work together to perform specific functions. Cell regeneration occurs through cell division and reproduction. Abnormal changes in cells can occur for many reasons. These abnormal cells reproduce in the same way, but they do not have the regulatory mechanisms to control growth. As a result, the abnormal cell growth proliferates in an uncontrolled and unrestricted way.
New growths of abnormal tissue are called neoplasms or tumors. They are classified according to their cell of origin and whether their manner of growth is benign, not invasive or spreading, or malignant, invasive and capable of spreading. The first part of the name indicates the particular cell or tissue. The suffix –oma indicates it is a tumor.
Four main classifications of tumors according to tissue type are:
- Carcinomas (cancers originating from epithelial cells).
- Lymphomas (cancers originating from organs that fight infection).
- Leukemias (cancers originating from organs that form blood).
- Sarcomas (cancers originating from connective tissue, such as bone or muscle).
HOW CANCER CAN BE SPREAD
Cancer can spread (metastasis) by direct extension to adjacent tissues, extension from lymph vessels into the tissues adjacent to lymphatic vessels, transportation by blood or lymph systems, and diffusion within a body cavity. The area in which malignant cells first seen is called the primary site. The regions to which cancer cells spread are secondary or metastatic sites.
Metastasis is one of the most discouraging characteristics of cancer because even one malignant cell can give rise to a metastatic lesion in a distant part of the body. Metastatic tumors are treated aggressively whenever possible to improve the quality of life and to lengthen survival time.
Benign tumors remain at the original site of their development. They may grow large, but their rate of growth is slower than that of malignant tumors. Benign tumors usually do not cause death unless their location impairs the function of a vital organ, such as the brain. On the other hand, malignant tumors grow rapidly, and, unless completely removed before metastasis has occurred, they are likely to spread.
CAUSES OF CANCER
Certain factors and agents appear to be related to the development of many cancers. Factors believed to cause cancer are called carcinogens. These include
- chemical agents,
- environmental factors,
- dietary substances,
- defective genes,
- And hormones.
Effects of tobacco smoke and nicotine are related to cancers of the lung, mouth, throat, neck, esophagus, pancreas, cervix, and bladder.
Prolonged exposure to certain chemicals such as asbestos and coal dust is associated with some cancers. Chemical substances in the workplace can cause cancer. Organs most affected are the lungs, liver, and kidneys because they are involved with biotransformation and excretion of chemicals.
Environmental factors include prolonged exposures to sunlight, radiation, pollutants, and possibly electromagnetic fields from microwaves, power lines, and cellular phones.
Diet is a risk factor in cancer development. What a person does not consume is as important as what he or she consumes. Food high in fat, smoked foods, foods preserved with salts or alcohol, and foods with nitrates are associated with an increased risk for cancer. Foods believed to reduce the risk of cancer are high in fiber, , (cabbage, broccoli), and high in carotene (winter squash, carrots, cantaloupe). Vitamins A, C, and E also seem to have anticancer value.
Viruses are implicated in many cancers. The cell changes incorporated into the genetic information by the virus may result in the formations of cancerous cells. An example is Kaposi’s sarcoma associated with human immunodeficiency virus (HIV) (Bullock, 1996).
Defective genes are responsible for diverse cancers. Some types of leukemia, retinoblastoma (eye tumor in children), and skin cancers are associated with genetic factors. Breast, prostate, and colorectal cancers are also associated with defective genes.
Medically prescribed interventions such as immunosuppressive drugs, hormone replacements and anticancer drugs have been associated with increased incidence of cancer in individuals or their offspring when exposed in utero.
SYMPTOMS OF CANCER
- Change in bowel or bladder habits.
- A sore that does not heal.
- Unusual bleeding or discharge.
- Thickening or lump in breast or elsewhere.
- Indigestion or difficulty in swallowing.
- Obvious change in wart or mole.
- Nagging cough or hoarseness.
-Cancer is diagnosed by history, physical examination, and diagnostic studies. In some cases the
-physical examination is unremarkable, but the client’s history is suspicious for cancer. In addition, the client is evaluated for risk factors.
Many diagnostic studies are used to establish a diagnosis of cancer. The physician, using information obtained during the history and physical examination, selects tests that help establish a diagnosis.
The chemical composition of blood and other body fluids is altered by the presence of specific cancers. Specialized tests have been developed for tumor markers, which are specific proteins, antigens, hormones, genes, or enzymes released by cancer cells. These include:
- Acid phosphatase: indicates that prostate cancer has metastasized to other parts of the body if blood levels of this enzyme are elevated.
- CA-19-9: detects an antigen that indicates pancreatic cancer.
- CA-125: measures the antigen that is diagnostic for ovarian cancer.
- Prostate specific antigen (PSA): detects prostate cancer when levels are elevated; this test is more specific than acid phosphatase.
Other laboratory tests may be useful in establishing a diagnosis. Although abnormal values do not directly indicate a malignant process, they may help in formulating a total clinical picture.
For example, a complete blood count may detect anemia in a client with possible colon cancer.
Occult blood in the stool may indicate colorectal cancer.
- X-ray studies: These studies, such as plain films or radiographs using contrast media or specialized equipment, detect tumors in specific organs. A contrast medium is a substance that highlights, outlines, or provides more detail than shown in a plain film. A barium enema is an example of a study done with contrast medium.
- Computed tomography (CT): The CT scan provides three-dimensional cross-sectional views of tissues to determine tumor density, size, and location.
- Magnetic resonance imaging (MRI): Similar to a CT scan, the MRI uses magnetic fields for sectional images. It helps visualize tumors hidden by bones.
- Radioisotope studies: These studies use radioactive materials (given orally or intravenously) to help diagnose various malignancies. A scanner then identifies areas of increased, decreased, or normal distribution.
- Ultrasound: Ultrasound uses high frequency sound waves to detect abnormal variations of a body organ or structure. The sound wave reflections are projected on a screen and may be recorded on film. These studies help differentiate solid and cystic tumors of the abdomen, breasts, pelvis, and heart.
- Biopsy: Tissue samples excised from the body are directly examined microscopically for malignant or premalignant processes. Tissue samples may be obtained during a surgical procedure, through insertion of a biopsy needle under local anesthesia, or during endoscopic procedures. A biopsy provides the most definitive method for diagnosing cancer.
- Endoscopy: Fiberoptic instruments are flexible tubes that contain optic fibers that enable light to travel in a straight line or at various angles and illuminate the area being examined. Specific areas of the body are examined with endoscopy. Tissue biopsies are done if a malignancy is suspected.
- Cytology: Microscopic examination of cells from various areas of the body is used to diagnose malignant or premalignant disorders. Cells are obtained via needle aspiration, scraping, brushing, or sputum. An example of a cytologic test is the Papanicolaou’s (Pap) smear used in diagnosing changes in the endometrium, cervix, and vagina.
Staging of Tumors
Before a client is treated for cancer, the tumor is staged and graded. The American Joint Commission on Cancer developed a grading system referred to as the TNM classification system:
T indicates the size of the tumor;
N stands for the involvement of regional lymph nodes;
M refers to the presence of metastasis.
A second classification system also stages tumors according to size, evidence of metastasis, and the presence or absence of lymph node involvement:
- Stage I: malignant cells are confined to the tissue of origin, no signs of metastasis.
- Stage II: limited spread of cancer in the local area, generally to area lymph nodes.
- Stage III: tumor larger or probably has invaded surrounding tissues or both.
- Stage IV: cancer has invaded or metastasized to other parts of the body.
MEDICAL MANAGEMENT OF CANCER
Three basic methods are used in the treatment of cancer:
(2) radiation therapy,
Another method, bone marrow transplantation, is also used for treating selected cancers.
Biotherapy, gene therapy, and other alternative therapies may also be used.
Cancer frequently is treated with a combination of therapies using established protocols.
Surgery may range from excision of the tumor alone to extensive excision, including removal of the tumor and adjacent structures such as bone, muscle, and lymph nodes. The type and extent of the surgery depends on the extent of disease, actual pathology, age and physical condition of the client, and anticipated results. When tumors are confined and have not invaded vital organs, the surgery is more likely to be curative. Surgery that helps to relieve uncomfortable symptoms or prolong life is considered palliative. Reconstructive or plastic surgery may be done after extensive surgery to correct defects caused by the original surgery. Some surgeries are disfiguring or are so profound that the client may have difficulty adjusting to body changes and disfigurement. In these cases, radiation therapy may be a better option.
Radiation therapy uses high-energy ionizing radiation, such as high-energy x-rays, gamma rays, and radioactive particles (alpha and beta particles, neutrons, and protons), to destroy cancer cells. The goal of radiation therapy is to destroy malignant, rapidly dividing cells without permanently damaging the surrounding healthy tissues. Normal and malignant cells can both be destroyed. However, the more rapidly reproducing malignant cells are more sensitive to radiation because radiation affects cells undergoing mitosis (cancer cells) more than cells in slower growth cycles (normal tissue). Radiation therapy is applied externally or internally, both with curative and palliative intent.
External radiation therapy makes use of high energy x-rays aimed at a specific location in the body. Expected side effects occurs as a result of the destruction of normal cells in the area being irradiated and are specific to the anatomic site treated. These include:
- alopecia (hair loss);
- erythema (local redness and inflammation of the skin);
- desquamation (shedding of epidermis; can be dry or moist);
- alterations in oral mucosa including stomatitis (inflammation of the mouth);
- xerostomia (dryness of the mouth);
- change or loss in taste, and decreased salivation;
- anorexia (loss of appetite); nausea; vomiting; diarrhea;
- cystitis (inflammation of the bladder);
- pneumonitis (inflammation of the lungs);
- fatigue; and bone marrow suppression if marrow producing sites are irradiated resulting in anemia (decreased red blood cells, decreased hemoglobin or volume of packed red blood cells), leucopenia (decreased white blood cell count), or thrombocytopenia (decreased platelet count).
Effects of radiation are cumulative and often the client experiences chronic or long-term side effects after therapy is completed.
Time refers to the length of exposure. The less time spent in the vicinity of a radioactive substance, the less radiation received. Nurses must plan carefully and work quickly and efficiently so minimal time is spent at the bedside. Careful psychological preparation helps the client accept the limited amount of nursing time.
Distance refers to the length in feet between the person entering the room and the radioactive source (the client). The rate of exposure varies inversely to the square of the distance from the source (client). For example, nurses standing 4 feet away from the source of radiation receive 25% of the radiation they would receive if they were standing 2 feet away from the source
Shielding is the use of any type of material to lessen the amount of radiation that reaches an area. The material usually used is lead, such as lead-lined gloves and lead aprons. Other materials, such as concrete walls, have the capability of shielding.
Pregnant women should avoid exposure to radioactive substances. When providing information, clients need to know: the type and duration of treatment; what is required of the client; possible side effects; skin and mouth care; nutritional and dietary concerns; and precautions needed.
Client and Family Teaching
For clients who will receive radiation therapy on an outpatient basis, it is important for the nurse to instruct the client to:
- Avoid the use of ointments or creams on the area receiving radiation therapy unless their use has been prescribed or recommended by a physician or radiation therapist.
- Avoid extremes of heat or cold: heating pads; ultraviolet light; diathermy; whirlpool, sauna, or steam baths; direct sunlight. If receiving radiation to the head or scalp, avoid shampooing with harsh shampoos (baby or mild shampoo is okay), tinting, permanent waving, hair dryers, curling irons, and hair products or treatments of any kind unless approved by the physician or radiation therapist.
- Bathe carefully. Avoid using soap and friction over the area being radiated. Skin markings must not be washed off because they are used as guides for setting and adjusting the treatment machine over the area to be radiated.
- Wear loose clothing to avoid irritation of the irradiated areas.
Chemotherapy uses antineoplastic drugs to destroy tumor cells, usually by interfering with cellular function and reproduction. Antineoplastic drugs are classified according to their relationship to cell division and reproduction.
Cell Cycle-Specific Drugs
Antineoplastic drugs are effective during any phase of the cell cycle, whether reproducing or resting. These drugs are used for larger tumors that are not as fast growing. The amount of drug given is more important than the frequency it is given. Examples of cell cycle-nonspecific agents are alkylating agents, antitumor antibiotics, nitrosureas and hormones.
Many drugs are given in combination with or following radiation therapy.
Routes and Devices for Administration of chemotherapy
Chemotherapeutic drugs are administered by a number of routes. The most common are the oral and intravenous (IV) routes, but they are also given intramuscularly, intraperitoneally, intraarterially,
intrapleurally, topically, intrathecally, or directly into a cavity.
Adverse Effects of Chemotherapy
Adverse effects associated with chemotherapy include:
- Nausea and vomiting are the most common adverse effects to occur during the first 24 hours after chemotherapy administration; use of concurrent antiemetics helps to reduce the incidence and severity.
- Stomatitis (inflammation of the mouth) and mouth soreness or ulceration: may occur as a result of destruction to the epithelial layer.
- Alopecia (loss of hair): occurs when rapidly growing cells of the hair follicles are affected by the chemotherapy.
- Bone marrow depression: inhibits the manufacture of red and white blood cells and platelets. Severe anemia, bleeding tendencies, leucopenia (abnormal decrease in white blood cell count), and thrombocytopenia (abnormal decrease in the number of platelets) may occur if bone marrow depression is profound. Blood transfusions may be necessary, as well as protection of the client from infections.